Is the quality of skin cancer screening in Germany related to the specialization of the physician who performs it?: Results of a nationwide survey among participants of skin cancer screening

The National Cancer Aid monitoring (NCAM-online) of ultraviolet radiation risk and protection behavior: a population-based observational trend study with four annual online survey waves

BACKGROUND

Ultraviolet (UV) radiation is the most important risk factor for skin cancer development. Sunlight is the main source of UV radiation in the general population. In addition, tanning beds are a source of artificial UV radiation. Since the incidence of skin cancer is increasing worldwide, it is necessary to monitor UV-related risk behaviors such as intentional indoor and outdoor tanning, as well as sun protection behavior in the general population and specific subgroups and settings. This is the aim of the National Cancer Aid Monitoring online (NCAM-online), a continuation and further development of the NCAM.

METHODS

The NCAM-online is a longitudinal trend study consisting of four annual survey waves. Each year, 4,000 individuals aged 16-65 years living in Germany will be surveyed using online questionnaires. Each year, intentional indoor and outdoor tanning will be assessed. In addition, varying specific topics regarding skin cancer prevention, such as the utilization of skin cancer screening, will be addressed in the questionnaires.

DISCUSSION

The findings of the NCAM-online will provide an important basis for the German Cancer Aid and Working Group on Dermatologic Prevention (Arbeitsgemeinschaft Dermatologische Prävention, ADP) to develop targeted prevention campaigns and projects aimed at preventing skin cancer. The explorative nature of the NCAM-online allows for the identification of new potential starting points for prevention and education. In addition, the longitudinal design allows for a description of the trend in the prevalence of intentional tanning. For tanning bed use, representative trend data from 2012 are available for Germany, to which NCAM-online will add annual data until 2027.

General practitioners' perspectives on statutory skin cancer screening-A questionnaire-based cross-sectional survey in Germany

BACKGROUND

In Germany, skin cancer screening (SCS) is available free of charge every two years to all those with statutory health insurance over the age of 35. General Practitioners (GP) can carry out the screening if they have completed an 8-hour training course. GPs play a crucial role in the implementation of SCS and act as gatekeepers between initial patient contact and referral to dermatologists.

OBJECTIVE

To record how comprehensively GPs carry out SCS in terms of patient information and body examination, as well as to explore GPs opinions on the feasibility of SCS.

METHODS

A cross-sectional survey was conducted. A questionnaire was sent to GPs with permission to perform SCS in two regions of Germany (Bavaria and Saxony) between August and September 2021. Data were analyzed using descriptive analysis. Subgroup analysis was performed according to regions (federal state, location of physician´s office), professional experience (experience in years, number of monthly screenings, age) and gender. Open questions were evaluated using qualitative content analysis.

RESULTS

In the survey, 204 GPs responded. Genitalia (40.7%, 83/203), anal fold (62.3%, 127/204) and oral mucosa (66.7%, 136/204) were the least examined body regions during screening. Information on risks (false-positive findings: 18.6%, 38/203; false-negative findings: 13.2%, 27/203; overdiagnosis: 7.8%, 16/203) and benefits (48.0%, 98/202) were not always provided. GPs who performed screenings more frequently were more likely to provide information about the benefits of SCS (p<0.001; >10 vs. <5 screenings per month). Opinions were provided on uncertainties, knowledge requirements, structural and organizational requirements of SCS, SCS training and evaluation. The organization and remuneration of the SCS programme was seen as a barrier to implementation. GPs expressed uncertainties especially in unclear findings and in dermatoscopy.

CONCLUSION

Uncertainties in the implementation of the SCS should be addressed by offering refresher courses. Good networking between GPs and dermatologists is essential to improve SCS quality.

Zusammenhang zwischen der Inzidenz früher Stadien und der Mortalität beim malignen Melanom - eine bevölkerungsbasierte ökologische Studie

Hintergrund

In Deutschland wurde 2008 ein flächendeckendes Hautkrebsscreening eingeführt, um die Hautkrebsmortalität und ‐morbidität zu senken. Noch unklar ist jedoch die Wirksamkeit des Programms. Wir untersuchen den Zusammenhang zwischen der Inzidenz von Melanom‐Frühstadien und Melanom‐Mortalität in den Folgejahren, wobei die Inzidenz von Melanom‐Frühstadien als Surrogatparameter für Screening‐Teilnahme und Früherkennung verwendet wird.

Methodik

Für 244 deutsche Landkreise wurden Daten zur Melanom‐Inzidenz von 2005–2016 und zur Melanom‐Mortalität von 2005–2018 erhoben. Die Zusammenhänge zwischen verschiedenen Maßen der Inzidenz und Mortalität wurden mit Korrelationsanalysen und linearen Regressionen untersucht.

Ergebnisse

Die Melanom‐Inzidenz früher Stadien (in situ und T1) stieg nach Einführung des Screenings (2005–2007 vs. 2008–2010) um 69%. Im Gegensatz dazu gab es bei der Mortalität keinen zeitlichen Trend. Die Korrelationen zwischen Inzidenz‐ und Mortalitätsvariablen lagen zwischen –0,14 und 0,10 (nicht signifikant). Die linearen Regressionsanalysen ergaben, dass die Mortalität sechs Jahre nach Einführung des Screenings mit zunehmendem Anstieg der Inzidenz früher Stadien abnimmt (b  =  –0,0029, 95%‐Konfidenzintervall [–0,0066; 0,0007]).

Schlussfolgerungen

Die geschätzten bevölkerungsbezogenen Auswirkungen des Hautkrebsscreenings auf die Melanom‐Mortalität waren minimal und nicht signifikant. Eine mögliche Wirksamkeit kann daher nicht nachgewiesen werden.

Association of early-stage incidence and mortality in malignant melanoma - a population-based ecological study

BACKGROUND

Germany-wide skin cancer screening was introduced in 2008 to reduce skin cancer mortality and morbidity. However, the effectiveness of the program is still unclear. We explore the relationship between early-stage melanoma incidence and melanoma mortality in subsequent years, using early-stage melanoma incidence as surrogate for screening participation and early detection.

PATIENTS AND METHODS

Data on melanoma incidence for 2005-2016 and melanoma mortality for 2005-2018 were obtained for 244 German counties. We investigated the correlation between several measures of incidence and mortality with correlation analyses and linear regressions.

RESULTS

Melanoma incidence of early stages (in situ and T1) rose by 69% between pre-screening (2005-2007) and screening period (2008-2010). In contrast, there was no temporal trend in mortality over time. Correlation coefficients between incidence and mortality variables ranged between -0.14 and 0.10 (not significant). Linear regression indicated that mortality 6 years after screening introduction decreases with increasing change in early-stage incidence (b = -0.0029, 95% confidence interval [-0.0066, 0.0007]).

CONCLUSIONS

The estimated population-based effects of skin cancer screening on melanoma mortality were minimal and not significant. A potential effectiveness cannot be demonstrated.

Referring high-risk individuals for lung cancer screening: A systematic review of interventions with healthcare professionals

OBJECTIVE

This systematic review described the effect of interventions aimed at helping Healthcare Professionals refer high-risk individuals for lung cancer screening. Primary outcomes included: patient outcomes such as lung cancer detection, screening for lung cancer, lung cancer treatments received and lung cancer mortality. Healthcare professionals' knowledge and awareness of lung cancer screening served as secondary outcomes.

METHODS

Experimental studies published between January 2016 and 2021 were included. The search was conducted in MEDLINE, CINAHL, ERIC, PsycARTICLES, PsycInfo and Psychology and Behavioral Sciences Collection. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool and the level of evidence was assessed using the Scottish Intercollegiate Guidelines Network grading system.

RESULTS

Nine studies were included. Nurse navigation, electronic prompts for lung cancer screening and shared decision-making helped improve patient outcomes. Specialist screenings yielded more significant incidental findings and a higher percentage of Lung-RADS 1 results (i.e. no nodules/definitely benign nodules), while Primary Care Physician screenings were associated with higher numbers of Lung-RADS 2 results (i.e. benign nodules with a very low likelihood to becoming malignant). An increase in Healthcare Professionals' knowledge and awareness of lung cancer screening was achieved using group-based learning compared to lecture-based education delivery.

CONCLUSIONS

The effectiveness of Nurse navigation is evident, as are the benefits of adequate training, shared decision-making, as well as a structured, clear and well-understood referral processes supported by the use of electronic system-incorporated prompts.